When moving a person to a stretcher you should?

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1. 1. Barry Kidd 2010Barry Kidd 2010 11 LIFTING ANDLIFTING AND MOVING PATIENTSMOVING PATIENTS Don’t put your back at riskDon’t put your back at risk
2. 2. Barry Kidd 2010 2 Moving and PositioningMoving and Positioning the Patientthe Patient  Take care to avoid injuryTake care to avoid injury whenever a patient is moved.whenever a patient is moved.  Practice using equipment.Practice using equipment.  Know that certain patientKnow that certain patient conditions call for specialconditions call for special techniques.techniques.
3. 3. Barry Kidd 2010 3 Body MechanicsBody Mechanics  Shoulder girdle should beShoulder girdle should be aligned over the pelvis.aligned over the pelvis.  Feet shoulder-width apartFeet shoulder-width apart  Keep backs straight.Keep backs straight.  Lift with legs.Lift with legs.  Keep weight close to theKeep weight close to the body.body.  Do not twistDo not twist  Grasp should be made withGrasp should be made with palms up.palms up. Wrong: Back Bent & Reaching
4. 4. Barry Kidd 2010 4 Performing the Power GripPerforming the Power Grip  A power grip gets the maximumA power grip gets the maximum force from your handsforce from your hands  Arms and hands face palm up.Arms and hands face palm up.  Hands should be at least 10" apart.Hands should be at least 10" apart.  Each hand goes under the handleEach hand goes under the handle with the palm facing up and thewith the palm facing up and the thumb extended upward.thumb extended upward.
5. 5. Barry Kidd 2010 5 Performing the Power GripPerforming the Power Grip  Curl fingers andCurl fingers and thumb tightly overthumb tightly over the top of thethe top of the handle.handle.  NeverNever grasp agrasp a litter or backboardlitter or backboard with the handswith the hands placed palms-downplaced palms-down over the handle.over the handle.
6. 6. Barry Kidd 2010 6 Performing the Power LiftPerforming the Power Lift  Tighten your back inTighten your back in normal upright position.normal upright position.  Spread your legs apartSpread your legs apart about 5".about 5".  Grasp with arms extendedGrasp with arms extended down side of body.down side of body. Adjust yourAdjust your orientation andorientation and position.position. Reposition feet.Reposition feet. Lift byLift by straighteningstraightening legs.legs.
7. 7. Barry Kidd 2010 7 Weight and DistributionWeight and Distribution  Patient will bePatient will be heavier on headheavier on head end.end.  Patients on aPatients on a backboard orbackboard or stretcher shouldstretcher should be diamondbe diamond carried.carried.
8. 8. Barry Kidd 2010 8 Diamond CarryDiamond Carry  Four EMRs lift deviceFour EMRs lift device while facing patient.while facing patient.  EMR at foot end turnsEMR at foot end turns around to face forwardaround to face forward..  EMR at sides turn.EMR at sides turn.  Four EMRs face sameFour EMRs face same direction when walking.direction when walking.
9. 9. Barry Kidd 2010 9 One-Handed CarryingOne-Handed Carrying  Face each otherFace each other and use bothand use both hands.hands.  Lift theLift the backboard tobackboard to carrying height.carrying height.  Turn in theTurn in the direction you willdirection you will walk and switchwalk and switch to using oneto using one hand.hand.
10. 10. Barry Kidd 2010 10 Carrying Backboard or Cot onCarrying Backboard or Cot on StairsStairs  Strap patientStrap patient securely to thesecurely to the backboard.backboard.  Carry patientCarry patient down stairs footdown stairs foot end first, headend first, head end elevated.end elevated.  Carry patient upCarry patient up stairs head endstairs head end first.first.
11. 11. Barry Kidd 2010 11 Using a Stair ChairUsing a Stair Chair  Secure patient to stair chair with straps.Secure patient to stair chair with straps.  Rescuers take their places: one at head, one atRescuers take their places: one at head, one at foot.foot.  Rescuer at the head gives directions.Rescuer at the head gives directions.  Third rescuer precedes.Third rescuer precedes.
12. 12. Barry Kidd 2010 12 Robinson Orthopedic StretcherRobinson Orthopedic Stretcher  Adjust stretcherAdjust stretcher length.length.  Lift patient slightlyLift patient slightly and slide stretcherand slide stretcher into place, one sideinto place, one side at a time.at a time.  Lock stretcher endsLock stretcher ends together.together.  Secure patient andSecure patient and transfer to the cot.transfer to the cot.
13. 13. Barry Kidd 2010 13 General ConsiderationsGeneral Considerations  Plan the move.Plan the move.  Look for optionsLook for options that cause thethat cause the least strain.least strain.
14. 14. Barry Kidd 2010 14 Directions and CommandsDirections and Commands  Anticipate and understand everyAnticipate and understand every move.move.  Moves must be coordinated.Moves must be coordinated.  Orders should be given in twoOrders should be given in two parts.parts.
15. 15. Barry Kidd 2010 15 Additional GuidelinesAdditional Guidelines  Find out how much the patientFind out how much the patient weighs.weighs.  Know how much you can safely lift.Know how much you can safely lift.  Communicate with your partners.Communicate with your partners.  Do not attempt to lift a patient whoDo not attempt to lift a patient who weighs over 250 lbs with fewer thanweighs over 250 lbs with fewer than four rescuers.four rescuers.  Avoid unnecessary lifting orAvoid unnecessary lifting or carrying.carrying.
16. 16. Barry Kidd 2010 16 Principles of Safe ReachingPrinciples of Safe Reaching and Pullingand Pulling  Back should always be locked and straight.Back should always be locked and straight.  Avoid any twisting of the back.Avoid any twisting of the back.  Avoid hyperextending the back.Avoid hyperextending the back.  When pulling a patient on the ground, kneel toWhen pulling a patient on the ground, kneel to minimize the distance.minimize the distance.
17. 17. Barry Kidd 2010 17 Principles of Safe ReachingPrinciples of Safe Reaching and Pullingand Pulling  Use a sheet or blanket if you mustUse a sheet or blanket if you must drag a patient across a bed.drag a patient across a bed.  Unless on a backboard, transferUnless on a backboard, transfer patient from the cot to a bed withpatient from the cot to a bed with a body drag.a body drag.  Kneel as close as possible toKneel as close as possible to patient when performing a log roll.patient when performing a log roll.
18. 18. Barry Kidd 2010 18 Principles of Safe ReachingPrinciples of Safe Reaching and Pullingand Pulling [3 of 3][3 of 3]  Elevate wheeled ambulance cot or stretcherElevate wheeled ambulance cot or stretcher before moving.before moving.  Never push an object with your elbows locked.Never push an object with your elbows locked.  Do not push or pull from an overhead position.Do not push or pull from an overhead position.
19. 19. Barry Kidd 2010 19 Emergency MovesEmergency Moves  Performed if there is some potentialPerformed if there is some potential danger for you or the patientdanger for you or the patient  Performed if necessary to reachPerformed if necessary to reach another patient who needs lifesavinganother patient who needs lifesaving carecare  Performed if unable to properlyPerformed if unable to properly assess patient due to locationassess patient due to location
20. 20. Barry Kidd 2010 20 Emergency DragsEmergency Drags  Clothes DragClothes Drag  Blanket dragBlanket drag
21. 21. Barry Kidd 2010 21 Emergency DragsEmergency Drags Arm-to-ArmArm-to-Arm DragDrag Arm DragArm Drag
22. 22. Barry Kidd 2010 22 One-Person Rapid ExtricationOne-Person Rapid Extrication
23. 23. Barry Kidd 2010 23 One-Rescuer Drags, Carries,One-Rescuer Drags, Carries, and Liftsand Lifts FrontFront cradlecradle Fire fighter’sFire fighter’s dragdrag
24. 24. Barry Kidd 2010 24 One-Rescuer Drags, Carries,One-Rescuer Drags, Carries, and Liftsand Lifts One-personOne-person walkingwalking assistassist FireFire fighter’sfighter’s carrycarry
25. 25. Barry Kidd 2010 25 One-Rescuer Drags, Carries,One-Rescuer Drags, Carries, and Liftsand Lifts Pack strapPack strap
26. 26. Barry Kidd 2010 26 Urgent MovesUrgent Moves  Used to move a patient whoUsed to move a patient who has potentially unstable injurieshas potentially unstable injuries  Use the rapid extricationUse the rapid extrication technique to move patientstechnique to move patients seated in a vehicle.seated in a vehicle.
27. 27. Barry Kidd 2010 27 When to Use RapidWhen to Use Rapid Extrication TechniqueExtrication Technique  Vehicle or scene is unsafe.Vehicle or scene is unsafe.  Patient cannot be properly assessed.Patient cannot be properly assessed.  Patient requires immediate care.Patient requires immediate care.  Patient’s condition requiresPatient’s condition requires immediate transport.immediate transport.  Patient is blocking access to anotherPatient is blocking access to another seriously injured patient.seriously injured patient.
28. 28. Barry Kidd 2010 28 Rapid ExtricationRapid Extrication  Provide in-Provide in- line supportline support and applyand apply cervicalcervical collar.collar.
29. 29. Barry Kidd 2010 29 Rapid ExtricationRapid Extrication  RotateRotate patient aspatient as a unit.a unit.
30. 30. Barry Kidd 2010 30 Rapid ExtricationRapid Extrication  Lower patientLower patient to theto the backboard.backboard.
31. 31. Barry Kidd 2010 31 Nonurgent MovesNonurgent Moves  DirectDirect groundground liftlift
32. 32. Barry Kidd 2010 32 Nonurgent MovesNonurgent Moves  ExtremityExtremity liftlift
33. 33. Barry Kidd 2010 33 Transfer MovesTransfer Moves Direct carryDirect carry Draw sheetDraw sheet methodmethod
34. 34. Barry Kidd 2010 34 GeriatricsGeriatrics  Emotional concernsEmotional concerns – FearFear  Skeletal concernsSkeletal concerns – OsteoporosisOsteoporosis – RigidityRigidity – KyphosisKyphosis – SpondylosisSpondylosis  Pressure soresPressure sores  Use special immobilizing techniques.Use special immobilizing techniques.  Be compassionate.Be compassionate.
35. 35. Barry Kidd 2010 35 BariatricsBariatrics  ““Care of the obese”Care of the obese”  Increase in back injuries amongIncrease in back injuries among EMTsEMTs  Manufacturing of higher capacityManufacturing of higher capacity equipmentequipment  Use proper lifting techniques.Use proper lifting techniques.
36. 36. Barry Kidd 2010 36 QUESTIONSQUESTIONS

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  A. Every time a patient is moved, the EMT-B must take special care so that no one is injured.
  B. Training and practice are required to use all the equipment described in this chapter.
  1. After each patient transfer, EMT-Bs should evaluate the appropriateness of the technique used, as well as the technical skill in completing the transfer.
  2. EMT-Bs must maintain equipment to the manufacturer’s specifications.
  C. Certain patient conditions, such as head injury, shock, spinal injury, and pregnancy, call for special lifting and moving techniques.
  1. Patients with chest pain or difficulty breathing should sit in a position of comfort, as long as they are not hypotensive.
  2. Patients with suspected spinal injuries must be immobilized on a long backboard.
  3. Patients in shock should be packaged and moved in a Trendelenburg position or supine with their legs elevated 6'' to 12''.
  4. Pregnant patients who are hypotensive should be positioned and transported on their left sides.
  5. Patients who are nauseated or vomiting should be transported in a position of comfort, and the EMT-B must be positioned appropriately to manage the airway.
  
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  A. Anatomy review
  1. When you are standing upright, the weight of anything you lift and carry in your hands is transferred to your shoulder girdle, your spinal column, your pelvis, and your legs.
  2. If your shoulder girdle is aligned over your pelvis and your hands are held close to your legs when you lift something, the force exerted against your spine occurs in an essentially straight line down the strong stacked vertebrae in the spinal column.
  3. With your back properly maintained in an upright position, little strain occurs against your muscles and ligaments, and significant weight can be lifted and carried without injuring your back.
  4. You may injure your back if you lift with your back curved and if you are bent significantly forward at the hips.
  5. The first rule of lifting is to always keep the back in a straight upright [vertical] position and to lift without twisting.
  
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  8. A power grip gets the maximum force from your hands whenever you are lifting a patient.
  a. The arm and hand have their greatest lifting strength when facing palms up.
  b. Your hands should be at least 10˝ apart whenever you grasp a cot or backboard.
  c. Each hand should be inserted under the handle with the palm facing up and the thumb extended upward.
  
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  d. Curl your fingers and thumb tightly over the top of the handle.
  e. Make sure that the underside of the handle is fully supported on your curved palm.
  f. Never grasp a cot or backboard with the hands placed palms down over the handle.
  
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  6. Power lift
  a. Tighten your back in normal upright position.
  b. Spread your legs approximately 15˝ apart.
  c. Extend your arms down side of your body and grasp the cot or backboard with hands held palms up.
  d. Adjust your orientation and position until the weight is balanced and centered between both arms.
  e. Reposition the feet so that they are about 15˝ apart with one slightly forward and rotated.
  f. With the arms extended downward, lift by straightening the legs until fully standing.
  7. Safety depends on using proper lifting techniques and having and maintaining a proper hold when lifting or carrying a patient.
  
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  A. If a patient is supine on a backboard or ambulance cot, weight is not equally distributed between both ends of the device.
  1. Between 68% and 78% of the body weight of a patient in a horizontal position is in the torso.
  2. More of the patient’s weight rests on the head half of the device than on the foot half.
  
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  B. A patient on a backboard or stretcher should be lifted and carried by four rescuers.
  1. Diamond carry: One EMT-B at the head end of the device, one at the foot end, and one at each side of the patient’s torso to balance the weight
  a. The four EMT-Bs should lift the device while facing the patient.
  b. Once the patient is lifted, the EMT-B at the foot end should turn around and face forward.
  c. The EMT-Bs at the sides should turn their hands at the torso palms down and face the feet.
  d. All four EMT-Bs should be facing the same direction and walking forward when carrying the patient.
  2. A patient should be carried feet first.
  a. This puts lightest load on the EMT-B at the patient’s feet.
  b. This allows a conscious patient to see in the direction of movement.
  
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  C. One-handed carrying technique is another lifting and moving technique.
  1. If four or more EMT-Bs are carrying a patient, each should use one hand to support the stretcher.
  2. Each EMT-B should face forward while walking.
  3. To lift the stretcher, at least two EMT-Bs should be on each side of the stretcher, facing each other. They should use both hands to lift.
  4. Once the stretcher is at carrying height, the EMT-Bs should turn in the direction they will be walking and switch to using one hand to carry the stretcher.
  5. EMTs should pick up and carry the stretcher with their backs in the locked position.
  
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  D. Whenever you must carry a backboard or stretcher up or down a flight of stairs, be sure that the patient is so secured to the device that he or she cannot slide significantly when the stretcher is at an angle.
  1. A strap that passes tightly across the upper torso and through each armpit, but not over the arms, is required.
  2. When you carry the patient down stairs, carry the foot end first so the head end is elevated higher than the foot end.
  3. When you carry a patient up stairs, the head end of the backboard or cot should go first.
  
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  F. Stair chair
  1. Use a wheeled stair chair to bring a conscious patient to the waiting cot, if the patient can be placed in a sitting position.
  2. Transfer the patient from the stair chair to the cot.
  
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  5. Scoop stretcher
  a. Adjust stretcher length.
  b. Lift the patient slightly and slide stretcher into place, one side at a time.
  c. Lock the stretcher ends together, avoiding pinching.
  d. Secure the patient and transfer to the cot.
  
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  A. Moving a patient should normally be done in an orderly, planned, and unhurried fashion to protect both the EMT-B and the patient.
  B. Carefully plan ahead and select the method[s] that will involve the least lifting and carrying.
  C. Always consider whether there is another option that will cause less strain on you and the other EMT-Bs.
  
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  A. To safely lift and carry a patient, anticipate and understand every move.
  1. Each move must be executed in a coordinated manner.
  2. Team leaders should indicate where each team member is to stand.
  B. Orders should be given in two parts.
  1. Preparatory command [ie, “All ready to stop.”]
  2. Command of execution [ie, “STOP!”]
  a. Deliver in a louder voice.
  b. Use a countdown when lifting a patient.
  i. Example 1: “We’re going to lift on three. One-two-THREE!”
  ii. Example 2: “I’m going to count to three and then we’re going to lift. One-two-three-LIFT!”
  
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  C. Additional lifting and carrying guidelines include:
  1. Find out how much the patient weighs before attempting to lift.
  2. Know how much you can comfortably and safely lift.
  3. If lifting the patient places strain on you, stop lifting and lower the patient.
  4. Obtain additional help before attempting to lift again.
  5. Communicate clearly and frequently with your partner and other rescuers whenever you are lifting a patient.
  6. Do not attempt to lift a patient who weighs more than 250 lb with fewer than four rescuers.
  7. Find out the weight limitations of the equipment you are using.
  8. Special techniques, equipment, and resources are required to move any patient who weighs more than 300 lb.
  9. The strongest of the available EMT-Bs should be located at the head end of the device.
  10. Whenever possible, use a stair chair instead of a stretcher to carry a patient down stairs.
  a. Secure the patient to the stair chair with straps.
  b. Rescuers take their places around the patient seated on the chair: one at the head and one at the foot.
  i. The rescuer at the head gives directions to coordinate.
  c. A third rescuer precedes the two carrying the chair to open doors and spot them on stairs.
  d. When reaching landings or other flat intervals, lower the chair to the ground and roll it rather than carrying it.
  e. When reaching the level where the cot awaits, roll the chair into position next to the cot in preparation for transferring the patient.
  11. Always remember to keep your back in the locked position.
  12. Flex at your hips, not at your waist.
  13. Bend your knees and keep the patient’s weight and your arms as close to your body as possible.
  14. Avoid any unnecessary lifting and carrying of the patient.
  
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  A. When using a body drag, apply the same basic body mechanics and principles as when lifting and carrying.
  1. The back should always be locked and straight.
  2. Avoid any twisting so that the vertebrae remain in normal alignment.
  3. Avoid hyperextending the back.
  4. When pulling a patient on the ground, kneel to minimize the distance that you will have to lean over.
  5. When a patient is at a different height from you, bend your knees until your hips are just below the height of the plane across which you will be pulling the patient.
  6. When pulling, extend your arms no more than about 15'' to 20'' in front.
  7. Keeping your reach within the recommended distance, reach forward and grasp the patient so that your elbows are just beyond the anterior torso.
  8. Reposition your feet so the force of pull will be balanced equally between both arms, and the line of pull will be centered between them.
  9. Pull the patient by slowly flexing your arms.
  10. When you can pull no further, stop and move back another 15'' to 20''. When properly positioned, repeat the steps.
  
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  11. If you must drag a patient across a bed, use the sheet or blanket under the patient.
  12. Unless the patient is on a backboard, transfer a patient from the ambulance cot to the bed with a body drag.
  13. Drag the patient in increments until he or she is properly centered on the bed.
  B. Sometimes during a body drag, you and another EMT-B may have to pull the patient with one of you on each side of the patient.
  1. Kneel just beyond the patient’s shoulder and face toward his or her groin.
  2. Extend one arm across and in front of your chest.
  3. Grasp the patient’s armpit. Extend the other arm in front and to the side of the torso and grasp the patient’s belt.
  4. Raise your elbows and flex your arms.
  5. Pull the patient with the line of force at the minimum angle possible.
  C. Log-rolling maneuver
  1. When log-rolling a patient onto his or her side, you will have to reach farther than 18''.
  2. To minimize this distance, kneel as close to the patient’s side as possible.
  3. Keep your back straight and lean forward solely from the hips.
  4. Roll the patient without stopping until the patient is resting on his or her side.
  
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  A. If there is some potential danger, use an emergency move to remove a patient to a safe place before conducting the initial assessment.
  1. The only other time an emergency move should be used is if the patient’s location or position prevents a proper assessment or delivery of immediate potentially critical emergency care.
  2. A single EMT-B working alone can use a drag to pull the patient along the long axis of his or her body to a safer position.
  3. The primary concern in an emergency move is the danger of aggravating an existing spinal injury.
  
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  B. Ways to move a patient on his or her back along the floor or ground include:
  1. Pulling on the patient’s clothing in the neck and shoulder area
  2. Placing the patient onto a blanket, coat, or other item that can be pulled
  
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  3. Rotating the patient’s arms so that they are extended straight on the ground beyond his or her head, grasping the wrists and, with the arms elevated above the ground, dragging the patient
  4. Placing your arms under the patient’s shoulders and through the armpits, grasping the patient’s arms, and dragging the patient backward
  
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  C. A single EMT-B working alone who must remove an unconscious patient from a car should take the following steps [one-person rapid extrication]:
  1. Move the patient’s legs so they are clear of the pedals.
  2. Rotate the patient so his or her back is positioned facing the open car door.
  3. Place your arms through the armpits and grasp either the patient’s forearms or your own forearms.
  4. Support the patient’s head against your body.
  5. Drag the patient from the seat to a safe location.
  6. If the legs and feet do not clear the car, slowly lower the patient until he or she is lying on his or her back next to the car, clear the legs, and use a long axis body drag to move the patient.
  
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  D. Other one-rescuer techniques include:
  1. Front cradle
  2. Fire fighter’s drag
  
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  3. One-person walking assist
  4. Fire fighter’s carry
  
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  5. Pack strap
  
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  A. Even if the scene is safe, an urgent move may be necessary for patients with an altered level of consciousness, inadequate breathing, or shock [hypoperfusion].
  B. When a patient sitting in a car or truck must be urgently moved, use the rapid extrication technique.
  
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  C. The rapid extrication technique requires a team of three EMT-Bs who are knowledgeable and practiced in the procedure.
  1. If the rapid extrication technique is used because the scene is dangerous, the cot should immediately be moved a safe distance away from the vehicle before the patient is assessed or treated.
  2. Steps of the rapid extrication technique must be considered a general procedure to be adapted as needed.
  3. The rapid extrication technique should be used only in life-threatening situations.
  a. The vehicle or scene is unsafe.
  b. The patient cannot be properly assessed before being removed from the car.
  c. The patient needs immediate intervention that requires a supine position.
  d. The patient’s condition requires immediate transport to the hospital.
  e. The patient blocks the EMT-B’s access to another seriously injured patient.
  
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  4. Rapid extrication technique
  a. Apply manual in-line support of the cervical spine.
  b. Team leader gives commands, applies c-collar and performs initial assessment.
  
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  c. Second EMT-B supports patient’s torso.
  d. Third EMT-B rotates patient’s feet and legs.
  
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  e. Patient must be moved as a unit.
  f. Patient is lowered to the backboard after being rotated.
  g. Patient is slid onto the backboard.
  
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  A. When both the scene and the patient are stable, the EMT-B should carefully plan how to move the patient.
  B. Three general methods may serve as a basis for planning, all of which can be adapted to meet the needs of specific case situations.
  1. Direct ground lift
  a. Used on patients without spinal injury
  b. Used if necessary to carry the patient some distance to cot
  c. Should be done by three EMT-Bs
  
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  2. Extremity lift
  a. Used on patients without spinal injury
  b. Helpful for carrying patients through narrow passages
  c. Communication and coordination essential
  
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  3. Transfer moves
  a. Direct carry: Lift patient then rotate to cot
  b. Drawsheet method: Lifting a patient by a sheet or blanket
  i. Place the cot next to the bed at same height as bed and hold it in place.
  ii. Loosen the sheet underneath the patient or log roll the patient onto a blanket.
  iii. Reach across the cot and grasp the sheet or blanket firmly at the patient’s head, chest, hips, and knees.
  iv. Gently slide the patient onto the cot.
  
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  A. Emotional concerns
  1. Fear of illness and disability
  2. Trip to hospital can be terrifying and disorienting.
  B. Skeletal changes
  1. Osteoporosis—brittle bones
  2. Rigidity
  3. Spinal curvatures
  a. Kyphosis—spinal curvature
  b. Spondylosis—spinal rigidity
  C. Pressure sores
  1. There is less fatty tissue on geriatric patients.
  2. Pressure sores and fractures can form from lying on a backboard even for a short amount of time.
  3. Pad backboard.
  D. Special immobilizing techniques
  1. May have to immobilize on side.
  2. Curvatures need to be filled with blankets and towels.
  3. Do not try to straighten to match immobilizing device.
  E. Use a sympathetic and compassionate approach.
  1. This can go a long way to reduce a patient’s fear.
  2. Slow down, explain, and anticipate.
  
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  A. Defined as care of the obese
  1. 100 million adults in U.S. are overweight or obese.
  B. Due to the increase in overweight and obese patients, more EMTs are experiencing back injuries.
  C. Ambulance equipment manufacturers are producing higher capacity cots and equipment.
  D. Follow proper lifting techniques.
  1. Have enough personnel.
  2. Use legs to lift, not back.
  

When you move a patient on a stretcher?

When transporting a patient on a stretcher the patient should be transported How?

Which action should the nurses take when moving a patient from the bed to the stretcher?